Clinical Risk Manager

CLINICAL RISK MANAGER

EASTERN ORGEON

SUMMARY:

The Clinical Risk Manager is to ultimately provide a safer hospital and clinic environment by mitigating or reducing risks for all individuals within the organization. Serves as a resource for all colleagues and providers on medico/legal concerns. Investigates Event Reports and EMTALA related concerns and identifies major trending patterns.

Analyzes allegations of claims and complaints against the organization, and corresponding documentation (including medical record review, security reports/video, etc.). Interviews employees, patients, families, and physicians for details of events. Documents chronological summaries of events and research processes in a medical/legal perspective. Participates in the risk management reduction strategies with the Risk Management team.

REQUIREMENTS:

1. Must have active RN license; BSN preferred.

2. Certified Professional in Healthcare Risk Management (CPHRM) preferred.

3. 3 years of nursing experience in a clinical role that gives exposure to Infection Control, Quality, Risk, etc. required

WHAT YOU WILL DO:

• Knows, understands, incorporates, and demonstrates the Organization's Mission, Vision, and Values in behaviors, practices, and decisions.

• Must be highly motivated and self-directed and can work independently. Must have strong written and verbal skills.

• Must have the ability to work under pressure with time constraints, including presenting to all associates in a respectful and professional manner as part of SAH’s Core Values Participates in daily Safety Huddles and provides reports for the department and support for other departments as needed.

• Assists in the oversight and maintenance of the system-wide Event reporting system.

• Analyzes Event reports to determine causes and to suggest remedial actions. Reassign events to appropriate department/clinic leadership and/or to peer review.

• Ascertain clinical course of patient from documentation and demonstrate knowledge of regular processes pertaining to nursing care, departmental/clinic functions, etc.

• In collaboration with the AOC, Clinical Coordinators, or applicable department/clinic leadership, determines and coordinates initiation, leading, and follow up of CERT’s and Root Cause Analysis (RCA) processes. Expert in Apparent Cause Analysis (ACA) and Common Cause Analysis (CCA) processes and can lead and/or provide guidance and education as needed.

• Oversees and tracks the implementation of corrective action plans resulting from the CERT’s, ACA’s RCA’s process, including Common Cause Analysis (CCA) as needed.

• Notifies TH insurance of all actual and potential adverse events, SRE’s, SSE’s and/or potential compensable events.

• Clinical Risk Manager will work with legal department to conduct EMTALA investigations and provides summary reports to legal for determinations on a case-by-case basis.

• Assists and/or coordinates debriefing processes as needed.

• Assists and /or coordinates disclosure processes with Providers and Administration as needed.

• Works collaboratively with the Patient Relations Department or group office managers/directors to complete appropriate responses on patient complaints and grievances, and/or assists with advice on patient concerns as needed. Serves as a lesion with Patient Relations or office manager/director if the patient grievance is elevated.

• Medical Group Clinical Risk Manager will work with providers and/or group managers/directors on patient dismissals/terminations.

• Assists with the billing adjustments and write off determinations, and Patient Accounts Review Team.

• Manages or supports processing of subpoenas, court orders or other legal requests from attorneys.

• Interacts with the system office to manage corporate lines of insurance (GL/PL, WC, property, auto, etc.) related issues/requests, i.e., certificates of insurance, renewal processing, claims histories, bonds, etc.

• Is the contact and local support for claims processing related to general or professional liability. Manages and uploads new claims in the STARs “Clear Sight” module.

• Interacts with claims management in the system office, local attorneys, and…